Dr. S came for his round in my ward..and I brought out my book quickly to refer back what I have done about the Factors influencing wound healing.
He remembered that he asked me the question, then he asked :" Was it difficult?"
Poor me, I'd answered :"Yes." stupid Hsin Ni. I shouldn't.
He seemed not satisfy how I answer his question. I answered without prioritize the level of importance. I answered Haemorrhage, Immunosuppressed status, Hypovolemic, and all the rubbish. The correct ones are Immuno compromised, Age, Nutritional status, Underlying Disease such as Diabetes, Cancer, then followed by those rubbish...like infection larr, hypoxia larr...
He said I am not confident.
He pointed out all all all my problems
He taught me
1. Greet ppl
2. Introduce myself
3. Answer out accordingly
4. Look straight into examiner's eye
My god...I presented my answers terribly. He gave me one more homework for me to improve on. The question is What is Septic Arthritis? Point out a diagnosis and list out the treatment available for this diagnosis and the time limit is 2 days.
Don't worry Dr, I'll improve and make you change your mind! Check me out!
1 comments:
Dear Hsin Ni,
I've got this from one of the college of medicine web. A simplified version. Hope this would be able to help you.
Septic Arthritis
Also known as: Infectious arthritis or Pyogenic arthritis
What is it?
Septic arthritis, also known as infectious arthritis or pyogenic arthritis, is a serious infection of the joints characterized by pain, fever, chills, inflammation and swelling in one or more joints, and loss of function in those joints.
Septic arthritis is considered a medical emergency because of the damage it causes to bone as well as cartilage, and its potential for creating septic shock, which is a potentially fatal condition.
Who gets it?
Septic arthritis can strike any age group, including infants and children. In adults, it most commonly affects weight-bearing joints such as the knee, while in children it is more common in the shoulders, hips, and knees. Risk factors include patients diagnosed with chronic rheumatoid arthritis, certain systemic infections, certain types of cancer, diabetes, sickle cell anemia, or systemic lupus erythematosus (SLE), IV drug abusers and alcoholics, and patients with artificial (prosthetic) joints. Patients with recent joint injuries or surgery, or patients receiving medications injected directly into a joint are also at a greater risk for developing septic arthritis.
What causes it?
Septic arthritis occurs when some type of infecting organism, most often bacteria, reaches a joint. Bacteria can get into a joint through the bloodstream, or through surgery, an injection, or injury that directly contaminates the joint. The cause of septic arthritis in babies and young children is usually staphylococci, hemophilus influenzae, and gram-negative bacilli. In adults and older children, septic arthritis is more commonly caused by gonococci, staphylococci, and streptococci. Mycobacteria, which causes tuberculosis, and the bacteria that causes Lyme disease can also cause septic arthritis. Intravenous drug users and people with diseases that weaken the immune system, such as HIV, are more likely to have septic arthritis caused by gram-negative bacteria. The staphylococcus organism can also be introduced to a joint during arthroscopic surgery and prosthetic joint surgery.
What are the symptoms?
Symptoms of septic arthritis occur suddenly and are characterized by severe pain, swelling in the affected joint along with acute pain. Chills and fever are also common symptoms. Septic arthritis in the hip may be experienced as pain in the groin area that becomes much worse if the patient tries to walk. In the majority of cases, there is some leakage of tissue fluid into the affected joint. The joint is sore to the touch, and may or may not be warm to the touch, depending on how deep the infection lies within the joint. Children sometimes develop nausea and vomiting.
How is it diagnosed?
Your doctor will diagnose septic arthritis based upon your symptoms, your medical history, a complete physical exam, and synovial fluid and blood tests. After numbing the area, he or she will withdraw a sample of synovial fluid from the affected joint. This fluid will be tested for white blood cells, which are usually high, and for bacteria and other organisms. Some of the joint fluid will be placed in a special container in which many types of bacteria can grow and be identified.
The doctor may perform an arthrocentesis, which is a procedure that involves withdrawing a sample of synovial fluid from the joint with a needle and syringe for testing. The doctor may also perform a culture of blood and urine to rule out other causes such as gout, acute rheumatic fever, rheumatoid arthritis, Lyme disease and other disorders that can cause a combination of joint pain and fever. In some cases, the doctor may consult a specialist in orthopedics or rheumatology to avoid misdiagnosis. Because septic arthritis can quickly destroy a joint unless treated, your doctor may also order x-rays to assess any joint damage.
What is the treatment?
Septic arthritis must be diagnosed quickly and treated with antibiotics. Your doctor may first give these antibiotics intravenously (through a vein) to make sure the infected joint receives medication to kill the bacteria as quickly as possible. Then, the remaining course of antibiotics is taken orally.
The doctor may also need to drain the fluid from the infected joints if it rapidly reaccumulates and causes symptoms. Immediate surgical drainage is reserved for septic arthritis of the hip, because that site is inaccessible for repeated fluid removal. For most other joints, surgical drainage is used only if medical therapy fails over two to four days to alleviate symptoms. Hot compresses and splinting the joint to provide it with rest and support can help relieve pain. After a period of rest, your doctor will recommend gentle exercise to prevent stiffness. If septic arthritis occurs in an artificial joint, antibiotic treatment may need to be followed by surgery to replace the joint. Most patients with no other serious underlying disease recover fully from septic arthritis with antibiotic therapy.
Recovery from septic arthritis is usually good with most patients undergoing treatment, although many patients will develop osteoarthritis or deformed joints. Children with infected hip joints sometimes suffer damage to the growth plate. Patients with severe damage to bone or cartilage may need reconstructive surgery, but it cannot be performed until the infection is completely gone.
Resource from: http://www.hmc.psu.edu/healthinfo/s/septicarthritis.htm
Cheers,
Tang
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